The Effect of Kangaroo Care on Behavioral Responses to Pain of an Intramuscular Injection in Neonates

PURPOSE. This study aims to assess the efficacy of Kangaroo Care (KC) on behavioral responses of term neonates to the pain of an intramuscular injection. DESIGN AND METHODS. One hundred healthy term neonates were enrolled and randomly assigned to intervention and control groups. In the intervention group, the neonate was held in KC for 10 min before the injection and remained in KC for the duration of the procedure. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score immediately after injection. RESULTS. The cumulative NIPS score immediately after injection in the intervention group was significantly lower (p < .001) than in the control group. PRACTICE IMPLICATIONS. KC given before injection seems to effectively decrease pain and should be considered for minor invasive procedures in neonates.     

早产儿袋鼠式护理的临床效果和母亲满意度的Meta分析

目的评价早产儿袋鼠式护理（kangaroo mother care，KMC）的临床效果和母亲对KMC满意度的影响。方法计算机检索PubMed、EMbase、Ovid、Spnnger数据库，中国期刊全文数据库，台湾电子期刊全文数据库，中国生物医学文献数据库；此外，还手工检索学术会议记录、专题论文集。检索时间均从建库至2007年9月。纳入袋鼠式护理早产儿的所有随机对照试验，并对纳入文献进行行质量评价。采用RevMan4．2软件进行Meta分析。结果最终纳入5篇随机对照试验。KMC组患儿病死率、重症感染发生率及12个月随访时精神运动功能发育与常规护理组比较，差异无统计学意义（P〉0．05）。KMC组院内感染发生率、6个月随访时的上呼吸道感染发生率及出院时牛奶喂养发生率均低于常规护理组（P〈0．05）。KMC组的母亲对早产儿在普通新生儿和重症监护病房对他（她）进行照顾的自信心较常规护理组增强，对早产儿在普通新生儿病房的担心和焦虑情况较常规护理组减轻、患儿出院时体重增加（P〈0．05）。结论Meta分析结果表明KMC是一种科学、有效、人性化的新生儿护理模式，但对患儿的死亡率和长期精神运动功能发育的影响还不能肯定，需要进行大样本、多中心的随机对照试验进行评价。     

Kangaroo Care and Behavioral and Physiologic Pain Responses in Very-Low-Birth-Weight Twins: A Case Study

The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants.     

Exposure to Contact Sports Results in Maintained Performance During Experimental Pain

During pain, motor performance tends to decline. However, athletes who engage in contact sports are able to maintain performance despite the inherent pain that accompanies participation. This may be the result of being challenged rather than threatened by pain; adaptive coping strategies; habituation to pain; or finding pain less bothersome. This study aimed to measure performance of a novel motor task both in pain and not in pain within experienced contact athletes (n = 40), novice contact athletes (n = 40), and noncontact athletes (n = 40). Challenge and threat perceptions were manipulated during the pain condition and measures of pain tolerance, perception, coping styles, and bothersomeness were taken. Results indicated that contact athletes, regardless of experience, were able to maintain their performance during painful stimulation. Noncontact athletes, conversely, performed significantly worse during pain stimulation. In addition, contact athletes tended to be more challenged and the noncontact athletes more threatened within the pain condition. Experienced contact athletes demonstrated higher levels of pain tolerance and direct coping, and reported lower levels of pain bothersomeness and intensity than the other groups. The results suggest that even relatively brief exposure to contact sports may be enough to help maintain performance in pain. Being in a challenged state appears to be an important factor during performance in pain. Moreover, pain tolerance, intensity, and bothersomeness may differentiate novice and experienced athletes.PerspectiveExposure to voluntary pain and challenge states are associated with adaptive responses to pain. Motor task performance may be maintained in individuals with more experience of sports-related pain.     

Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial

ContextTreatment of pain in palliative care patients is challenging. Adjunctive methods of pain management are desirable. Music therapy offers a nonpharmacologic and safe alternative.ObjectivesTo determine the efficacy of a single music therapy session to reduce pain in palliative care patients.MethodsTwo hundred inpatients at University Hospitals Case Medical Center were enrolled in the study from 2009 to 2011. Patients were randomly assigned to one of two groups: standard care alone (medical and nursing care that included scheduled analgesics) or standard care with music therapy. A clinical nurse specialist administered pre- and post-tests to assess the level of pain using a numeric rating scale as the primary outcome, and the Face, Legs, Activity, Cry, Consolability Scale and the Functional Pain Scale as secondary outcomes. The intervention incorporated music therapist-guided autogenic relaxation and live music.ResultsA significantly greater decrease in numeric rating scale pain scores was seen in the music therapy group (difference in means [95% CI] ?1.4 [?2.0, ?0.8]; P < 0.0001). Mean changes in Face, Legs, Activity, Cry, Consolability scores did not differ between study groups (mean difference ?0.3, [95% CI] ?0.8, 0.1; P > 0.05). Mean change in Functional Pain Scale scores was significantly greater in the music therapy group (difference in means ?0.5 ([95% CI] ?0.8, 0.3; P < 0.0001).ConclusionA single music therapy intervention incorporating therapist-guided autogenic relaxation and live music was effective in lowering pain in palliative care patients.     

Effect of Kangaroo Care and Oral Sucrose on Pain in Premature Infants: A Randomized Controlled Trial

BackgroundPremature infants hospitalized in the neonatal intensive care unit are routinely exposed to many painful procedures. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates, hence pain in infants should be reduced. Kangaroo care and oral sucrose are some of the methods that can help reduce pain.AimThis study aimed to compare the effects of kangaroo care and oral sucrose on pain relief in preterm infants during heel lancing.MethodsOur study involved 64 infants. The infants were randomly divided into two groups using a randomized block design of drawing out slips from a thick, non-transparent envelope. There were 64 slips in this envelope (32 for kangaroo care and 32 for oral sucrose). Kangaroo care was given to the preterm infants in the first group and oral sucrose to those in the second group. In both groups, heart rate and oxygen saturation were measured and pain score was evaluated by two observers using the Premature Infant Pain Profile (PIPP) before, during, and 2 minutes after blood sampling by heel lancing.ResultsThere was a statistically significant difference between the groups in favor of the kangaroo group in terms of change in the PIPP values after heel lancing. Kangaroo care is more effective than oral sucrose in pain relief during heel lancing in preterm infants.ConclusionsIn addition to many benefits it offers to infants, kangaroo care can be used to reduce pain during painful procedures in premature infants.     

Neonatal nurse skills and Kangaroo Mother Care (KMC) training: One year post-training evaluation

Perinasia's Kangaroo Mother Care (KMC) training could improve the competence of health officers' knowledge and skills. Both trying the module and evaluating its results are important.AimThis study aimed to assess the skills of neonatal nurses one year after KMC training in the Pasar Rebo District General Hospital.MethodA qualitative approach that included in-depth interviews, group discussions, and observations of the neonatal nurses’ skills in KMC was implemented. Thematic analysis was performed.ResultsA year after follow-up, there was neither KMC training nor a clear policy. It was mentioned that there was a standard operating procedure (SOP) of KMC and routine transfer of health personnel. However, there were no KMC IEC materials or free KMC gowns to support the training.ConclusionThe development of KMC services in the hospital not only provided training for health personnel but also required continuation, a clear policy, a SOP, and education support materials.     

Assessing Pain Behaviors in Healthy Subjects Using the Critical-Care Pain Observation Tool (CPOT): A Pilot Study

The Critical-Care Pain Observation Tool (CPOT) is a behavioral scale recommended by experts for pain assessment in critically ill patients unable to verbally communicate. The main goal of this study was to determine the relationship between self-reports of pain intensity and the CPOT score, and establish the sensibility and the specificity of the CPOT to different levels of pain intensity in healthy subjects. A total of 18 healthy subjects participated in the study (mean age = 37.8 years). All subjects underwent a 2 minutes noxious cold pressor test (CPT) at 7°C. Verbal pain ratings were obtained with a visual analog scale (0-100) while pain behaviors were videotaped. Afterwards, 2 independent evaluators quantified pain behaviors using the CPOT. Interrater reliability was supported with an ICC of 0.963 (95%CI [0.904-0.986]). A moderate positive correlation between the CPOT scores and self-reports of pain intensity during the CPT was found (r = 0.52, p = 0.028). Such result indicates that subjects reporting high level of pain showed a higher number or more intense pain behaviors. A cut-off score >2.5/8 on the CPOT led to a sensibility of 64% and a specificity of 86%. Results from this pilot study support that an increase of CPOT score is correlated with moderate to high levels of pain intensity and further support the clinical use of the CPOT.     

A Trial of a Brief Group-Based Form of Acceptance and Commitment Therapy (ACT) for Chronic Pain in General Practice: Pilot Outcome and Process Results

Acceptance and commitment therapy (ACT) is a developing approach for chronic pain. The current study was designed to pilot test a brief, widely inclusive, local access format of ACT in a UK primary care setting. Seventy-three participants (68.5% women) were randomized to either ACT or treatment as usual (TAU). Many of the participants were aged 65 years or older (27.6%), were diagnosed with fibromyalgia (30.2%) and depression (40.3%), and had longstanding pain (median = 10 years). Standard clinical outcome measures included disability, depression, physical functioning, emotional functioning, and rated improvement. Process measures included pain-related and general psychological acceptance. The recruitment target was met within 6 months, and 72.9% of those allocated to ACT completed treatment. Immediately post treatment, relative to TAU, participants in ACT demonstrated lower depression and higher ratings of overall improvement. At a 3-month follow-up, again relative to TAU, those in ACT demonstrated lower disability, less depression, and significantly higher pain acceptance; d = .58, .59, and .64, respectively. Analyses based on intention-to-treat and on treatment “completers,” perhaps predictably, revealed more sobering and more encouraging results, respectively. A larger trial of ACT delivered in primary care, in the format employed here, appears feasible with some recommended adjustments in the methods used here (Trial registration: ISRCTN49827391).     

Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process

Objective

The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities.

Feeding Outcomes in Preterm Infants After Discharge From the Neonatal Intensive Care Unit (NICU): A Systematic Review

Optimal growth and successful feeding in the neonatal intensive care unit (NICU) are difficult to achieve, and data indicate premature infants continue to struggle after discharge. The purpose of this systematic review was to identify growth and feeding outcomes in the NICU published within the last 10 years. Available evidence suggests weight-for-age decreases between birth and discharge from the NICU, and continues to lag behind expectations after discharge. Prevalence rates of breastfeeding differ across countries, with declining rates after discharge from the NICU. Interventions focused on increasing breastfeeding rates are effective. Most healthy preterm infants successfully nipple feed at a gestational age ≥ 36 weeks, but infants may be discharged prior to achieving full oral feeding, or eating with poor coordination. Earlier born preterm infants are later at achieving full oral feedings. After discharge, preterm infants are slower to develop eating skills, parental reports of feeding problems are prevalent, and parents introduce solids to their infants earlier than recommended. This review enhances professionals’ understanding of the difficulties of feeding and growth in preterm born infants that are faced by parents.